AIM:To assess,in a routine practice setting,the sus-tained virologic response(SVR) to telaprevir(TPV) or boceprevir(BOc) in hepatitis c virus(HcV) nullresponders or relapsers with severe liver ***:One hundred twenty-f...
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AIM:To assess,in a routine practice setting,the sus-tained virologic response(SVR) to telaprevir(TPV) or boceprevir(BOc) in hepatitis c virus(HcV) nullresponders or relapsers with severe liver ***:One hundred twenty-five patients were treated prospectively for 48 wk with TPV or BOc + pegylated-interferon(peg-INF) α2a + ribavirin(PR) according to standard treatment schedules without *** patients were treated in routine practice settings in 10 public or private health care centers,and the data were prospectively *** patients with severe liver fibrosis(Metavir scores of F3 or F4 upon liver biopsy or liver stiffness assessed by elastography),genotype 1 HcV and who were null-responders or relapsers to prior PR combination therapy were included in this ***:The Metavir fibrosis scores were F3 in 35(28%) and F4 in 90(72%) of the *** total,62.9% of the patients were null-responders and 37.1% relapsers to the previous PR *** overall SVR rate at 24 wk post-treatment withdrawal was 59.8%.The SVR was 65.9% in the TPV group and 44.1% in the BOc *** predictive factors of an SVR included a response to previous treatment,relapsers vs null-responders [OR = 3.9;(1.4,10.6),P = 0.0084],a rapid virological response(RVR) [OR 6.9(2.6,18.2),P = 0.001] and liver stiffness lower than 21.3 kPa [OR = 8.2(2.3,29.5),P = 0.001].During treatment,63 patients(50.8%) had at least one severe adverse event(SAE) of grade 3 or 4.A multivariate analysis identified two factors associated with SAEs:female gender [OR = 2.4(1.1,5.6),P = 0.037] and a platelet count below 150 × 103/ mm3 [OR = 5.3(2.3,12.4),P ≤ 0.001].cONcLUSION:More than half of these difficult-to-treat patients achieved an SVR and had SAEs in an actual practice *** SVR rate was influenced by the response to previous PR treatment,the RVR and liver stiffness.
Hepatitis c virus(HcV) affects about 3% of the world's population and peaks in subjects aged over 40 years. Its prevalence in pregnant women is low(1%-2%) in most western countries but drastically increases in wom...
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Hepatitis c virus(HcV) affects about 3% of the world's population and peaks in subjects aged over 40 years. Its prevalence in pregnant women is low(1%-2%) in most western countries but drastically increases in women in developing countries or with high risk behav-iors for blood-transmitted infections. Here we review clinical, prognostic and therapeutic aspects of HcV in-fection in pregnant women and their offspring infected through vertical transmission. Pregnancy-related im-mune weakness does not seem to affect the course of acute hepatitis c but can affect the progression of chronic hepatitis c. In fact, postpartum immune res-toration can exacerbate hepatic inflammation, thereby worsening the liver disease, particularly in patients with liver cirrhosis. HcV infection increases the risk of gestational diabetes in patients with excessive weight gain, premature rupture of membrane and caesarean delivery. Only 3%-5% of infants born to HcV-positive mothers have been infected by intrauterine or perinatal transmission. Maternal viral load, human immunode-ficiency virus coinfection, prolonged rupture of mem-branes, fetal exposure to maternal infected blood con-sequent to vaginal or perineal lacerations and invasive monitoring of fetus increase the risk of viral transmis-sion. cesarean delivery and breastfeeding increases the transmission risk in HcV/human immunodeficiency virus coinfected women. The consensus is not to offer antivi-ral therapy to HcV-infected pregnant women because it is based on ribavirin(pregnancy category X) because of its embryocidal and teratogenic effects in animal spe-cies. In vertically infected children, chronicc hepatitis is often associated with minimal or mild liver disease and progression to liver cirrhosis and hepatocarcinoma is lower than in adults. Infected children may be treated after the second year of life, given the adverse effects of current antiviral agents.
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